Servoi%20ventilator

1
Servoi ventilator

• Charles Gomersall
• Dept of Anaesthesia Intensive CareThe Chinese
  University of Hong KongPrince of Wales Hospital

Version 1.1
2
Disclaimer

• Although considerable effort has been taken to
  ensure that the material in this tutorial
  accurately reflects the information provided by
  Maquet AB in its publications the author takes no
  responsibility for the accuracy of the
  information in this tutorial nor for any adverse
  event that occurs as a result of using this
  tutorial. Users are advised to consult the manual
  that accompanies their ventilator. Please note
  that this tutorial has not been endorsed by
  Maquet AB.

3
Navigation
Whats different from a 300A?
4
User interface a quick tour
Whats different from a 300A?
Setting the mode
Modes
Changing parameters
Alarms
Advanced
Starting up
Click on Maquet to end the tutorial at any stage
5
A quick tour
6
Menu touch pad
7
Using the menu touch pad
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Additionalsettings
Additionalvalues
8
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Additionalsettings
Additionalvalues
9
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
10
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
11
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
12
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
13
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
14
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
15
Text and alarm messages appear here
16
Alarmpofile
Fixed keys
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
17
Silence/pre-silence alarms
Alarmpofile

• Silences or pre-silences alarms for 2 minutes

Additionalsettings
Startbreath
O2breaths
Exp.hold
Insp.hold
18
Silence/pre-silence alarms
Alarmpofile
158

• Silences or pre-silences alarms for 2 minutes
• After silencing an alarm the Alarm silence symbol
  is shown with the remaining time

Startbreath
O2breaths
Exp.hold
Insp.hold
19
Silence/pre-silence alarms
055

• When alarms are pre-silenced a pre-silence symbol
  is shown as well as the remaining mute time

20
Alarm profile

• Press this button to
• Display upper and lower alarm limits
• Adjust preset limits
• Adjust the alarm sound level

21
Alarm profile
Alarm sound level
Upper
Lower
100
40
Pressure cm H2O
Minute Ventilation l/min
5.0
40.0
Respiratory Rate b/min
5
30
End Exp. Pressure cmH2O
3
Autoset
Additionalvalues
Cancel
Accept
22
Save

• Saves
• Current curve values
• Current parameter values
• Setting values
• 10 secs before and 10 secs after pressing key

23
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Recording
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
24
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Additionalsettings
Additionalvalues
25
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Menu
Alarm
Review
Options
Compliancecomp.
Copy data
Biomed
Panel lock
Changepatient category
Close
Additionalsettings
Additionalvalues
26
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Menu
Alarm
Trends
Review
Recordedwaveforms
Options
Compliancecomp.
Copy data
Biomed
Panel lock
Changepatient category
Close
Additionalsettings
Additionalvalues
27
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Recorded waveforms 12/25/02 143210
50 cmH2O
40 cmH2O
70 l/min
0 l/min
-70
700 ml
475 ml
0.0 s
Additionalvalues
Settings
Cursor
Close
28
(No Transcript)
29
Trends graphs
1432 Recording saved
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
30
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Recorded waveforms 12/25/02 143210
50 cmH2O
40 cmH2O
70 l/min
0 l/min
-70
700 ml
475 ml
0.0 s
Additionalvalues
Settings
Cursor
Close
31
Trends graphs
1442
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
32
Trends graphs
1442
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
33
Trends graphs
1442
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
34
Trends graphs
1432
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
35
Trends graphs
1438
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
36
Trends graphs
1432
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
37
Trends graphs
1438
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
38
Trends graphs
1438
l/min 2
?
Vee
0
0
l/min 20
10.5 10.0
MVi MVe
0
ml 800
VTi VTe
300 296
?
0
1400
1500
Cursor
Hours 1
Close
39
i

• This function is not currently available

40
Main rotary dial
41
Using the main rotary dial
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
.
Additionalsettings
Additionalvalues
42
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
.
Additionalsettings
Additionalvalues
43
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
.
Additionalsettings
Additionalvalues
44
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
45
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
46
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
47
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
48
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
.
49
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
.
50
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
.
51
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
52
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 550
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
.
Additionalvalues
Cancel
Accept
53
Measured values appear here
54
Pmean
12
PEEP
6
RR (b/min)
30
15
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
7.4
6.0
VTi
501
VTe
493
Additionalsettings
Additionalvalues
55
Pmean
12
PEEP
6
RR (b/min)
30
15
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
7.4
6.0
VTi
501
VTe
493
Additionalsettings
Additionalvalues
56
Expiratory MinuteVolume Low
Pmean
12
PEEP
6
RR (b/min)
30
15
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
5.2
6.0
VTi
356
VTe
346
Additionalsettings
Additionalvalues
57
Respiratory Rate High
Pmean
12
PEEP
6
RR (b/min)
30
31
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
8.5
6.0
VTi
292
VTe
274
Additionalsettings
Additionalvalues
58
Respiratory Rate High
Pmean
12
PEEP
6
RR (b/min)
30
31
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
8.5
6.0
VTi
292
VTe
274
Additionalsettings
Additionalvalues
59
Pmean
12
PEEP
6
RR (b/min)
30
15
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
7.4
6.0
VTi
501
VTe
493
Additionalsettings
Additionalvalues
60
Pmean
12
PEEP
6
RR (b/min)
30
15
5
O2 ()
48
42
36
IE
12.0
MVe (l/min)
8.5
7.4
6.0
VTi
501
VTe
493
Additionalsettings
Additionalvalues
61
Ppeak
34
Pplat
24
Pmean
12
PEEP
5
RR
15
O2
21
Vee
0
IE
12.0
MVe
7.0
MVi
7.5
VTi
501
VTe
471
Additionalsettings
Nextpage
62
Ppeak
34
Pplat
24
Pmean
12
PEEP
5
RR
15
O2
21
Vee
0
IE
12.0
MVe
7.0
MVi
7.5
VTi
501
VTe
471
Additionalsettings
Nextpage
63
Additionalsettings
Nextpage
64
Additionalsettings
Nextpage
65
Additionalsettings
Nextpage
66
Alarmprofile
Save
Trends
i
Additionalsettings
Additionalvalues
Special function keys
!
Startbreath
O2breaths
Exp.hold
Insp.hold
67
Special function keys

• Start breath
• Activates a set breath
• O2 breaths
• Changes the FiO2 to 1.0 for one minute
• Can be interrupted by re-pressing within one
  minute

68
Special function keys

• Expiratory hold
• Produces an expiratory pause hold for measuring
  total PEEP
• Lasts as long as the key is pushed up to a
  maximum of 30 secs
• Inspiratory hold
• Produces an inspiratory pause hold for measuring
  plateau pressure
• Lasts as long as the key is pushed up to a
  maximum of 30 secs

69
Alarmprofile
Save
Trends
i
Quickstart
Menu
Mainscreen
Additionalsettings
Additionalvalues
Direct access knobs
!
Startbreath
O2breaths
Exp.hold
Insp.hold
70
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• Parameter controlled by each direct access knob
  depends on ventilation mode selected
• Turn the knob to the desired value shown in the
  box above the knob

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
71
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• Parameter controlled by each direct access knob
  depends on ventilation mode selected
• Turn the knob to the desired value shown in the
  box above the knob

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
72
Direct access knobs
ModePressureControl
Automode
Admitpatient
Nebulizer
Status

• Parameter controlled by each direct access knob
  depends on ventilation mode selected
• Turn the knob to the desired value shown in the
  box above the knob

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
73
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• If the bar in the box is white the setting is
  within what is generally considered safe limits

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min

cm H2O
mmHg
74
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• If the bar turns yellow the setting is outside
  what are generally considered safe limits

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min

cm H2O

mmHg
75
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• If the bar turns red the setting is significantly
  outside what are generally considered safe limits
• An audible alarm and alarm message is given

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min

cm H2O

mmHg
76
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• When you come to a safety limit the knob is
  inactive for 2 seconds in order to make you aware
  that you have passed a safety limit

Additionalsettings
Additionalvalues
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min

cm H2O

mmHg
77
Direct access knobs
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• NB When you turn a direct access knob the changes
  in ventilation take place from the next breath
  without additional confirmation

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
78
Alarmprofile
Save
Trends
i
Quickstart
Menu
Mainscreen
Additionalsettings
Additionalvalues
Mains indicator
!
Startbreath
O2breaths
Exp.hold
Insp.hold
79
Alarmprofile
Save
Trends
i
Quickstart
Menu
Mainscreen
Additionalsettings
Additionalvalues
Start/stop ventilation (standby)
!
Startbreath
O2breaths
Exp.hold
Insp.hold
80
Waveform area
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
81
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
82
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
83
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
84
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
85
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
86
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
T
50 cmH2O
70 l/min
-70
700 ml
Additionalsettings
Additionalvalues
Startbreath
O2breaths
Exp.hold
Insp.hold
87
Alarmprofile
Save
Trends
Patient category
i
Quickstart
Menu
Mainscreen
Additionalsettings
Additionalvalues
!
Startbreath
O2breaths
Exp.hold
Insp.hold
88
Whats different from a Servo 300/300A?
89
Volume control
Volume support
Pressure support
Inspiratory rise time
User interface
Apnoea time
Automode
SIMV
90
Volume control
91
Volume control

• 300 and 300A
• If patients breathing effort reaches 2 cm H2O
  below preset PEEP ventilator permits a higher
  flow
• pressure is then regulated to 2 cm H2O above PEEP

• Servoi
• If a pressure drop of ?3 cm H2O is detected
  during inspiration the ventilator switches to
  pressure support, resulting in increased flow
• When flow ? to calculated target level flow
  maintained until set tidal volume delivered

92
Volume support
93
Minute volume

• 300 or 300A
• If RR lt set RR (ie minute vol. lt set minute vol.)
• new target VT is calculated (based on preset
  minute volume) used to regulate insp. pressure
• Max. VT 150 of preset

• Servoi
• Neither RR nor minute volume are set
• Inspiratory pressure is regulated purely based on
  preset VT

94
Inspiratory rise time

• 300 and 300A
• Inspiratory rise time set as a of breath cycle
  time, which is in turn dependent on set RR

• Servoi
• Inspiratory rise time set as
• in control and SIMV modes
• absolute time (s) in support modes. (NB. As a
  result the proportion of inspiration taken up by
  rise time will increase with RR)

95
I-E cycling

• 300 and 300A
• I-E cycling occurs when inspiratory flow 5 of
  maximum inspiratory flow

• Servoi
• I-E cycling occurs when inspiratory flow set
  of maximum inspiratory flow
• Set inspiratory cycle-off

96
Apnoea back-up

• 300 and 300A
• Apnoea gt 20 secs (adults)? pressure regulated
  volume control

• Servoi
• Apnoea gt set apnoea time? Back-up mode (volume
  control)

97
Pressure support
98
Apnoea back-up

• 300 and 300A
• None

• Servoi
• Apnoea gt set apnoea time? Back-up mode (pressure
  control)

99
Inspiratory rise time

• 300 and 300A
• Inspiratory rise time set as a of breath cycle
  time, which is in turn dependent on set RR

• Servoi
• Inspiratory rise time set as an absolute time (in
  seconds).
• NB. As a result the proportion of inspiration
  taken up by rise time will increase with RR

100
I-E cycling

• 300 and 300A
• I-E cycling occurs when inspiratory flow 5 of
  maximum inspiratory flow

• Servoi
• I-E cycling occurs when inspiratory flow set
  of maximum inspiratory flow
• Set inspiratory cycle-off

101
Inspiratory rise time
102
Inspiratory rise time

• 300 and 300A
• Always set as a of cycle time

• Servoi
• Set as a of cycle time control modes and SIMV
• Set as an absolute time in support modes

103
Apnoea time

• 300 and 300A
• Preset
• Adult 20 s
• Paediatric 15 s
• Neonate 10 s

• Servoi
• Adjustable in volume support, pressure
  support/CPAP and SIMV modes
• Press Alarm profile to set time
• Adult 15-45 s
• Infant 5-15 s

104
SIMV

• 300 and 300A
• SIMV cycle
• SIMV period

• Servoi
• SIMV cycle
• SIMV period set breath cycle time

105
SIMV

• 300 and 300A
• Mandatory (SIMV) breath given at end of SIMV
  period if patient does not trigger ventilator
  during SIMV period

• Servoi
• Mandatory (SIMV) breath given after 90 of SIMV
  period if patient does not trigger ventilator in
  initial 90 of SIMV period

106
Automode

• 300A
• Ventilator shifts from control to spontaneous
  mode if patient triggers 2 consecutive breaths

• Servoi
• Ventilator shifts from control to spontaneous
  mode if patient triggers ventilator

107
Automode

• 300A
• Ventilator shifts from spontaneous to control
  mode after a set period of apnoea
• Adult 12 s
• Paediatric 8 s
• Neonate 5 s

• Servoi
• Ventilator shifts from control to spontaneous
  mode after trigger time-out period
• Increases with each successive breath until the
  set trigger timeout limit is reached

108
Setting the mode
109
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Additionalsettings
Additionalvalues
110
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
Tidal volume 500
IE12.0
Trigger sensitivityV
Resp. Rate15
T. pause10
PEEP5
T. Insp. rise5
O2 conc.40
Additionalvalues
Cancel
Accept
111
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Volume control ?
Automode
Ti 1.33 s (33)
Select ventilation mode
Volume control
SIMV (Vol. Control)Pressure Support
.
Pressure control
SIMV (Press. Control)Pressure Support
PRVC
SIMV (PRVC)Pressure Support
Pressure Support/CPAP
Volume Support
Additionalvalues
Cancel
Accept
112
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
113
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
114
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
115
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
116

• If the bar in the box is white the setting is
  within what is generally considered safe limits

117

• If the bar turns yellow the setting is outside
  what are generally considered safe limits

118

• If the bar turns red the setting is significantly
  outside what are generally considered safe limits

119
Inspiratory rise time

• Can be altered to increase patient comfort
• Some patients find sudden bolus of gas
  uncomfortable
• Excessively long rise time can result in
  receiving preset levels of ventilatory support
  for relatively short periods

120
Inspiratory rise time

• Control modes and SIMV
• Rise time set as a of cycle time
• SIMV
• Cycle time is set
• Control modes
• Cycle time 60/RR

121
Inspiratory rise time

• Support modes
• Rise time set as an absolute time
• Proportion of inspiratory time that is taken up
  by rise time increases as cycle time shortens (ie
  increased RR)

122
Triggering
123
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
124
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Trigger sensitivity -2 -20
0

Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
Resp. Rate15
T. Insp. rise5
PEEP5
O2 conc.40
Additionalvalues
Cancel
Accept
125
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Automode
Additionalsettings
Additionalvalues
126
Automode

• When automode has been selected the soft key
  turns white

127
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Control mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

128
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Control mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

129
Automode Volume support
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Support mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

130
ModeVolume Control
Automode
Admitpatient
Nebulizer
Status
Set ventilation mode
Pressure control ?
Automode
Ti 1.33 s (33)
Basic
IE
Trigger
.
PC above PEEP 18
IE12.0
Trigger sensitivityV
PS above PEEP20
Resp. Rate15
T. Insp. rise5
Insp. cycle off5
PEEP5
Trigger timeout7
O2 conc.40
Additionalvalues
Cancel
Accept
131
Automode

• Automode can only be set in association with the
  following modes of ventilation
• Volume control
• Pressure regulated volume control
• Pressure control

132
Modes
Volume control
Volume support
Pressure control
Pressure support/CPAP
PRVC
SIMV
Automode
Back up ventilation
133
Volume control

• volume preset assist/control ventilation
• ventilator delivers preset volume in preset
  inspiratory time with preset pause time and
  preset flow pattern
• when triggered by the patients respiratory
  efforts
• as determined by the preset ventilatory rate

134
Volume control
50 cmH2O
70 l/min
-70
700 ml
135
Volume control

• Ventilator will deliver breaths to ensure preset
  frequency is achieved
• In general preset volume is delivered according
  to preset waveform for all breaths
• With the Servo i it possible for the patient to
  obtain a higher inspiratory flow and tidal volume
  from the ventilator than is pre-set

136
Volume control

• Flow is usually dependent on preset volume and
  the inspiratory time.
• Inspiratory time is determined by the IE ratio
  and the respiratory rate
• If the flow does not meet patient demand the flow
  is automatically increased.

137
Volume control

• If a pressure drop of ?3 cm H2O is detected
  during inspiration the ventilator switches to
  pressure support, resulting in increased flow
• When flow ? to calculated target level flow
  maintained until set tidal volume delivered

138
Volume control
Flow
Time
Insp.time
Pausetime
Exp time
139
Volume control
Flow
Time
Insp.time
Pausetime
Exp time
140
Pressure control

• Pressure preset assist/control ventilation
• Similar to volume control except pressure is
  preset
• Inadequate flow unlikely to be a problem

141
Pressure control
PC above PEEP
Pressure
PEEP
Flow
142
Pressure control

• Theoretical decrease in risk of barotrauma
• Improved oxygenation due to decelerating flow
  pattern
• Risk of hypoventilation as lung compliance falls
• monitor tidal and minute volumes

143
Pressure regulated volume control

• Preset tidal volume delivered in preset
  inspiratory time at preset frequency
• Ventilator automatically adapts inspiratory
  pressure control level to changes in mechanical
  properties of chest
• Inspiratory pressure constant
• Inspiratory flow decelerating

144
PRVC
Pressure
Flow
Volume
145
PRVC
Upper Pressure limit
5 cm H2O
Pressure
Flow
Volume
146
PRVC

• Has the advantages of pressure control
  ventilation without the disadvantage of potential
  hypoventilation/over-ventilation as chest
  compliance changes

147
PRVC

• With automode off
• PRVC
• With automode on
• PRVC if patient is apnoeic
• VS if patient is triggering the ventilator

148
PRVC

• In this mode the pressure is titrated to the
  tidal volume
• should not be used in a situation where the
  inspiratory tidal volume leaving the ventilator
  is not an accurate reflection of delivered tidal
  volume (eg circuit leak, uncuffed tube)

149
Volume support

• Every breath is patient triggered
• Pressure square wave with decelerating flow
• Ventilator automatically titrates pressure to
  achieve preset tidal volume with the lowest
  possible pressure

150
Volume support
Upper Pressure limit
5 cm H2O
Pressure
10 cm H2O
Flow
Volume
151
Volume support
Upper Pressure limit
5 cm H2O
Pressure
10 cm H2O
Flow
Volume
152
Volume support

• If apnoea time is exceeded ventilator
  automatically
• Alarms and switches to Back up mode (volume
  control with default settings) if Automode is off
• Remains in Back up mode until alarm is reset

153
Pressure support/CPAP

• With both PS and PEEP gt0
• pressure support ventilation with PEEP
• With PEEP 0
• pressure support ventilation
• With PS 0
• PS of 2 cmH2O plus PEEP

154
Pressure support

• inspiratory assist
• constant preset airway pressure supplied during
  inspiration

155
Pressure support
PS above PEEP
Pressure
PEEP
Flow
Volume
156
Pressure support
PS above PEEP
Pressure
PEEP
Flow
Volume
157
Pressure support

• allows patient to control inspiratory and
  expiratory times, inspiratory flow and tidal
  volumes. This control can improve patient comfort
• can be combined with SIMV or CPAP or used on its
  own in patients whose gas exchange is improving
  and in whom weaning is being attempted

158
Pressure support

• pressure support of 3.5-14.5 cmH2O required to
  overcome the additional work of breathing due to
  breathing through ETT and demand valve. Patients
  who require pressure support of lt 6 cmH2O can
  probably be extubated
• may unload respiratory muscles and reduce
  diaphragmatic fatigue

159
Pressure support

• disadvantages
• VT and minute ventilation variable, excessively
  large VT may be delivered
• high initial flow and termination algorithm may
  be unsuitable for severe airflow obstruction

160
Back-up ventilation

• Operates in association with volume support and
  pressure support/CPAP
• Does not operate when Automode is on

161
Back-up ventilation
Pressure controlDefault pressure PS or 20
cmH2O Default IE ratio Default respiratory
rate Default inspiratory rise time
Pressuresupport/CPAP
Apnoeagtset apnoea time
162
Back-up ventilation
Volume controlVT set VT Default IE
ratio Default respiratory rate Default
inspiratory rise time
Volumesupport
Apnoeagtset apnoea time
163
SIMV (VC) PS

• patient can breathe spontaneously but also
  receives a set number of volume controlled
  mechanical breaths
• volume controlled breaths are synchronized with
  the patients breathing to prevent the
  possibility of a mechanical breath on top of a
  spontaneous breath
• remaining breaths are pressure supported

164
SIMV
Pressure support above PEEP
Pressure
PEEP
Time
Flow
Time
Trig
Trig
165
SIMV (VC) PS

• If the patient is apnoeic the ventilator delivers
  volume controlled breaths at the preset SIMV rate
• If the patient triggers the ventilator the
  response of the ventilator depends on the point
  in the ventilator cycle at which triggering occurs

166
SIMV (VC) PS

• Time is split up into a series of SIMV cycles
• duration of each SIMV cycle

167
SIMV (VC) PS

• Each SIMV cycle is made up of 2 parts
• SIMV period
• breath cycle time
• spontaneous period

168
SIMV cycle
SIMV period
Volume controlled breath
Pressure supported breath
T
T
169
Volume controlled breath
90 of SIMV period
170
SIMV (PC) PS

• Very similar to SIMV (VC) PS except that
  controlled breaths are pressure rather than
  volume controlled

171
SIMV (PRVC) PS

• Very similar to SIMV (VC) PS except that
  controlled breaths are PRVC breaths rather than
  volume controlled breaths

172
Automode

• Active in VC, PC and PRVC modes
• When automode is on ventilator switches between
  control and spontaneous modes based on presence
  or absence of triggering

173
Automode
Pressurecontrol
Pressuresupport
Apnoea
Triggering
Volumecontrol
Volumesupport
Apnoea
Triggering
PRVC
Volumesupport
Apnoea
Triggering
174
Automode

• Trigger timeout
• duration of apnoea before ventilator switches
  from support mode to control mode
• The limit increases with each successive breath
  until the set trigger timeout limit is reached

175
Automode

• When automode has been selected the soft key
  turns white

176
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Control mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

177
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Control mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

178
Automode Volume support
ModeVolume Control
Automode Volume support
Admitpatient
Nebulizer
Status

• Support mode

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
Tidal volume 500
ml
b/min
cm H2O

179
Changing the parameters
180
Changing parameters
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• Direct access knobs
• Additional settings

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
181
Changing parameters
ModePressure Control
Automode
Admitpatient
Nebulizer
Status

• Direct access knobs
• Additional settings

Additionalsettings
Additionalvalues
O2 conc. 30
PEEP 5
Resp. rate 15
PC above PEEP 15
mmHg
b/min

cm H2O
182
AlarmsThis module will be available in later
versions of this tutorial
183
Starting up
184
(No Transcript)
185
Pre-use check
186
Standby
Do you want to start Pre-use check?
Yes
No
to start ventilation
Press
Additionalsettings
Additionalvalues
187
Standby
Do you want to start Pre-use check?
Yes
No
to start ventilation
Press
Additionalsettings
Additionalvalues
188
(No Transcript)
189
Pre-use check

• Do not use the ventilator if it does not pass the
  pre-use check

190
Check batteries
191
(No Transcript)
192
Status
Additionalsettings
Additionalvalues
193
Status
Status
General
Version Universal
Serial no. 2017
Pre-use check Passed 2002-02-06 1452
Operating time 167 hours
Next Preventative Maintenance 1423 hours
Battery backup time 312 min
Barometric pressure 1023 hPa
Air Pressure 394 kPa100
O2 pressure 401 kPa100
O2 cell
Exp. cassette
Modules
Options
Pre-use check
Additionalsettings
Additionalvalues
194
Status
Status
General
Version Universal
Serial no. 2017
Pre-use check Passed 2002-02-06 1452
Operating time 167 hours
Next Preventative Maintenance 1423 hours
Battery backup time 312 min
Barometric pressure 1023 hPa
Air Pressure 394 kPa100
O2 pressure 401 kPa100
O2 cell
Exp. cassette
Modules
Options
Pre-use check
Additionalsettings
Additionalvalues
195
Status
Status
General
Modules status

Battery 52 min, Slot position 1
Battery 51 min, Slot position 2
Battery 49 min, Slot position 3
Battery 52 min, Slot position 4
Battery 52 min, Slot position 5
Battery 52 min, Slot position 6

O2 cell
Exp. cassette
Modules
Options
Pre-use check
Additionalsettings
Additionalvalues
196
AdvancedThis module will be available in later
versions of this tutorial
197
Alarm messages

• This module will be available in a later version
  of this tutorial